Healthcare Provider Details

I. General information

NPI: 1144826298
Provider Name (Legal Business Name): MARY ELIZABETH DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PHILLIP STONE WAY
CENTRAL CITY KY
42330-1929
US

IV. Provider business mailing address

222 PHILLIP STONE WAY
CENTRAL CITY KY
42330-1929
US

V. Phone/Fax

Practice location:
  • Phone: 270-754-3494
  • Fax: 270-754-3499
Mailing address:
  • Phone: 270-754-3494
  • Fax: 270-754-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015833
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015423
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: